System and method for clinical intelligent agents implementing an integrated intelligent monitoring and notification system

ABSTRACT

A method includes: receiving, at a clinical intelligent agent, patient specific data comprising information regarding the condition of the patient in a room; determining an event requiring action has occurred with respect to the patient, wherein the determining comprises comparing, using a monitor of the clinical intelligent agent, the patient specific data with historical reference data; displaying one or more alerts on a patient screen; scoring, using the clinical intelligent agent, the one or more alerts, wherein the scoring comprises escalating the one or more alerts based upon a response to the one or more alerts; and prioritizing, using the clinical intelligent agent, care provider tasks displayed on the patient screen based on the score of the one or more alerts. Other aspects are described and claimed.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation application of U.S. patentapplication Ser. No. 16/283,155, filed Feb. 22, 2019, and titled “Systemand Method for Clinical Intelligent Agents Implementing An IntegratedIntelligent Monitoring And Notification System”, which is a continuationof and claims benefit to U.S. patent application Ser. No. 12/648,343,filed Dec. 29, 2009, now U.S. Pat. No. 10,217,063, issued on Feb. 26,2019, and titled “System and Method for Clinical Intelligent AgentsImplementing An Integrated Intelligent Monitoring And NotificationSystem”, which claims the benefit of U.S. Provisional Patent ApplicationNo. 61/141,730, filed Dec. 31, 2008, and titled “System and Method forClinical Intelligent Agents Implementing An Integrated IntelligentMonitoring And Notification System”, the contents of each priorapplication is incorporated herein by reference as if set forth in itsentirety.

BACKGROUND OF THE INVENTION Field of the Invention

The present invention related to systems and methods for monitoringpatient conditions and history and issuing notifications based on suchmonitoring.

Description of the Related Art

Events that trigger a need for patient care management require access toprompt communication of information for sound and prompt decision makingand intervention.

Appropriate dissemination of timely information and the communication ofcritical events and specific details, such as background (historicalinformation) with changing conditions and results, to the appropriatestaff is vital to proactive intervention in patient care.

Effective communication and escalation based on severity and acceptableintervention response, and the automated management of this interventionis essential to effective response to a critical situation or thedevelopment of adverse conditions. The present state of this art is amanual monitoring of complex related information from disparate sourcesand manual monitoring of the progress.

The present state of the communication is informal and tenuous. Ascaregivers are notified, their response and changes in the circumstancesare monitored.

Currently, there does not exist an efficient method to monitor criticalevents in patient care, disseminate the information, and then monitorthe intervention and results, and produce historical reports foranalysis.

SUMMARY OF THE INVENTION

In a first aspect, the invention provides a method, comprising:receiving, at a clinical intelligent agent, patient specific datacomprising information regarding the condition of the patient in a roomof a healthcare facility; determining an event requiring action hasoccurred with respect to the patient, wherein the determining comprisescomparing, using a monitor of the clinical intelligent agent, thepatient specific data with historical reference data comprising healthconditions and safety checks with related dependencies and identifying,based upon the comparing, the patient specific data corresponds to apattern of decompensation of the patient; displaying, using the alertingagent, one or more alerts, produced for the event requiring action, on apatient screen located in the room; scoring, using the clinicalintelligent agent, the one or more alerts, wherein the scoring comprisesescalating, based upon rules stored in a repository of the clinicalintelligent agent, the one or more alerts based upon a response to theone or more alerts, wherein the escalating comprises evaluating, using amonitoring system, each of the one or more alerts over time to generateupdated scores for the one or more alerts; and prioritizing, using theclinical intelligent agent, care provider tasks displayed on the patientscreen based on the score of the one or more alerts, wherein theprioritizing comprises dynamically changing the care provider tasks asthe one or more alerts are escalated.

BRIEF DESCRIPTION OF THE DRAWINGS

The drawing is a conceptual block diagram of a system in accordance withan embodiment of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

In various aspects, the present invention relates to a system and methodfor clinical intelligent agents that monitor complex conditions andpatient history to trigger alerts to an advanced notification system.The system and method can monitor complex situations that affect patientcare and safety, and automatically generate alerts using multiplecommunication routes based on the severity of the situation withescalation capability. As used in this description, a clinicalintelligent agent is a complex database model and application componentthat can be dynamically configured to detect clinical patterns,conditions, events that have occurred or should occur, and/orcombinations of medical criteria to actively seek out impendingconditions/situations in order to proactively react with appropriateremediation, tasks and notification processes.

As shown in the drawing, a typical implementation includes a clinicalintelligent agent engine 100, and an intelligent data repository 200with triggers and multidimensional alert specification capabilities,patient specific XML (Extensible Markup Language) per room 400, areal-time alerting agent with paging 500, an alerting repository 600, anotification/escalation rules repository with response protocol 700,caregiver specific alerts and tasks (which are broad in scope andcontext) routed to a patient at a glance display 800, and a smart roomapplication with receivers 900. The clinical intelligent agent engine100, and the intelligent data repository 200 are collectively referredto as an integrated intelligent monitoring and notification system 300.The integrated intelligent monitoring and notification system can beconfigured in any suitable manner as would be appreciated by one skilledin the art. Utilizing XML format enables seamless integration of datarepositories for both inbound and outbound communication processes aswell as dynamic analysis of the data based on the clinical intelligentagent monitoring criteria.

The clinical intelligent agent 100 includes an input for receivingpatient specific information. It monitors conditions that exist withmultiple dependencies and analyzes the conditions to detect a patternthat can be used to alert staff of potential concern. The patientspecific data can be produced and delivered to the input accordance withknown techniques, including manual data entry and automatic transfer ofinformation captured by various sensing devices.

The intelligent data repository 200 includes a complex database ofreference data representative of health conditions and safety checkswith related dependencies. The data includes trigger criteria that isused to determine if an event has occurred that requires action. Oncesuch an event is detected, an alert is produced and sent via an outputto an alerting agent. This repository can handle complexmultidimensional monitors. These monitors can be implemented insoftware, and are designed to understand relationships between data andevents without limit to the criteria involved. The monitors can relatedto each other as well—the results of one monitor affecting the analysisof another. The monitors can analyze current data and events as well ashistorical events and patterns. The monitors can also analyze facility,tracking and clinical criteria, such as patient precaution orcontamination, who (and when) was in contact with the patient, where thepatient was and when, and relationship with overall facility (overall orspecific to unit and/or room and/or bed) locations and personal as wellas patient stay information—such as length of stay and associated alertsor processes. Additionally, the monitors can analyze the specificresults of tasks and staff utilization and dynamically make assignmentmodifications to meet the demands and improve processes. For instance,these monitors can detect patterns of decompensation (clinicaldeterioration pattern) of a patient to proactively react, provideintervention and alert medical staff of the situation with escalationand notification procedures to automatically trigger at each stageappropriate for the specific pattern of decompensation and patientcondition.

The alerting agent 500 includes software that analyzes medical recordsdata and searched for conditions that meet the alert repositorycriteria. This system allows the collection, synthesis, updating andexchange of information needed to respond to the alert and communicationstate. The alert repository contains both current alerts and historicalalerts. These alerts can be associated with any number of triggercriteria for extensive analysis of the data for decision support, totrigger real-time alerts and detail the current and past environments.The clinical intelligent agent configuration parameters contain theescalation criteria and apply these criteria to the alert or task orevent to determine a current score. These alerts, tasks and events aremonitored to escalate the score and/or notification as appropriate,based on the escalation criteria.

As alerts are produced, an alert is sent to the appropriate notificationsource and repository 600. The response to the alert is monitored andthe alert can be escalated as appropriate using rules stored in arepository 700. Additional situational parameters can escalate or reducethe alert status based on changes in the situation. The escalationprocess uses a monitoring system to evaluate each alert or task or eventand applies an associated algorithm to a plurality of parametersincluding a weighted value, incremental escalation value, multiplier,initial time to trigger, and elapsed time before triggering escalationlevels (unlimited), and associated notification and events/tasks totrigger based on the level (unlimited)—this comprises the current score.These scores are also used to prioritize tasks and to dynamically changeworkload/assignments as well as for historical analysis processing.Notifications processes trigger when scores reach defined levels.

As the caregiver enters the room, a patient at a glance screen (PAG) 800can be used to display clinical intelligent agent alerting events 600,current caregiver tasks due within the hour with timestamps for duetime, precautions, allergies and general patient information.

Examples of alerts based on status include: heart patient, medicationschanges, labs become abnormal; dialysis patient/heart patient, fluidbalance change, labs abnormal; patient flagged ‘at risk’ due to currentregulatory requirements; and patient flagged ‘at risk’ due to currentindividual hospital initiatives.

In one embodiment, the clinical intelligent agent includes a pluralityof components that can be implemented as software modules that run onone or more computers. The components include an alert event component,a conditions configuration component, and an agent alert patterncomponent.

The alert event component can provide a plurality of functionsincluding: location tracking and trending by facility, unit, room andbed; patient tracking an trending; event time tracking; alert type, modecategories and time tracking; pattern recognition; historical recordingand reporting of events; remediation tracking for process improvementtied to associated conditions and events; dynamic customization;historical trending with dynamic abnormal patter and condition alerts;dynamic notification of normal and abnormal values; and alert routingand escalation role notification roles to alert associations.

The conditions configuration component can include data elements withminimum, normal and critical value ranges, and can provide a course ofaction repository.

The agent alert event component can provide a plurality of functionsincluding: pattern conditions; pattern relationships; a notificationmode including notification parties, roles and levels; an escalationmode based on time and events, escalation incremental values, escalationtime periods and stages; and precaution alerts.

The agent alert event component enables location tracking and trendingby specific location, including for example, facility, unit, and roomand/or bed breakdown. Additionally the component enables patienttracking and trending of the alerting events. These events can be timestamped to enable the historical detailed event state.

Alert types, mode and categories can be used to create patternassociations for triggers to create events.

Historic recording and monitoring of these events and patterns can beused to trigger additional alerts and notifications

Remediation events are also tracked and can trigger process improvementevents.

Components are tied to associated conditions and events which can bedynamically configured.

Events, patterns (normal and abnormal), and associations can bedynamically customized without modification of the application.

Alert routing, escalation, and role notifications are associated witheach alert.

The conditions configuration component facilitates the use of minimum,normal and critical value ranges. These associates can be used totrigger a source of action event as defined in the repository.

The clinical intelligent agent alert pattern component embodies apattern of conditions, relationships, a notification mode, notificationroles, levels and parties, and an escalation mode based on time andevents, escalation incremental weighted values to specify significanceof time to event, escalation time period and stages, and precautionaryalerts.

The clinical intelligent agents (CIAs) respond to a complex repositoryand monitoring system that analyzes a dynamic repository. It acts as anintegrated intelligent monitoring and notification system (IIMNS). It isa large-scale automated communication system integrated into anintelligent database with triggers to provide for accurate patientsituational awareness to the appropriate parties and/or caregiver.

This real-time tracking and notification system is event and data drive,with triggers for appropriate notification based on severity,incorporating automated escalation capability as well as tracking theintervention status and state of the response. This will result in amore efficient use of resources as well as a more timely response. Sinceall data will be captured, it will be available for historical eventanalysis using statistical algorithms to improve/enhance responsemeasures and protocols based on past experience.

The above description describes a system and method for improvedtracking and notification of patient condition and safety concerns. Thefunctions illustrated in the FIGURE can be implemented in a computer orcomputer system, that is programmed to perform the functions andincludes the hardware needed to input, store and process the data, andto produce alerts in the described method. In one embodiment, theinvention can be implemented using a computer readable medium includinginstructions for configuring a computer system to receive patientspecific data; process the patient specific data; provide alerts whenthe processing determines that action is needed; and notify careproviders when the processing determines that action is needed.

While the invention has been described in terms of several embodiments,it will be apparent to those skilled in the art, that various changescan be made to the described embodiments without departing from thescope of the invention as set forth in the following claims.

What is claimed is:
 1. A method comprising: receiving, at a clinicalintelligent agent, patient specific data comprising informationregarding the condition of the patient in a room of a healthcarefacility; determining, using the clinical intelligent agent, an eventrequiring action has occurred with respect to the patient, wherein thedetermining comprises comparing, using a monitor of the clinicalintelligent agent, the patient specific data with historical referencedata comprising health conditions and safety checks with relateddependencies and identifying, based upon the comparing, the patientspecific data corresponds to a pattern of decompensation of the patient;displaying, using an alerting agent of the clinical intelligent agent,one or more alerts produced for the event requiring action, on a patientscreen located in the room; scoring, using the clinical intelligentagent, the one or more alerts, wherein the scoring comprises escalating,based upon rules stored in a repository of the clinical intelligentagent, the one or more alerts based upon a response to the one or morealerts, wherein the escalating comprises evaluating, using a monitoringsystem, each of the one or more alerts over time to generate updatedscores for the one or more alerts; and prioritizing, using the clinicalintelligent agent, care provider tasks displayed on the patient screenbased on the score of the one or more alerts, wherein the prioritizingcomprises dynamically changing the care provider tasks on the display asthe one or more alerts are escalated.
 2. The method of claim 1, whereinthe processor determines if the patient specific data exceeds triggercriteria in the historical reference data.
 3. The method of claim 1,further comprising sending the one or more alerts to care providers,wherein the sending comprises using predetermined notification rules toset a notification protocol for sending at least one of a page, e-mailor telephone call to care providers.
 4. The method of claim 3, whereinthe sending the one or more alerts to care providers is responsive tothe score of the one or more alerts reaching a predefined threshold. 5.The method of claim 1, further comprising tracking and trending eventsidentified by the processor based on a comparison of the patientspecific data with the historical reference data.
 6. The method of claim5, wherein the events are time stamped to enable a historical detailedevent state.
 7. The method of claim 6, further comprising creatingpattern associations for triggers used to identify the events.
 8. Themethod of claim 5, further comprising recording and monitoring theevents to trigger additional alerts.
 9. The method of claim 1, furthercomprising tracking remediation actions to identify processimprovements.
 10. The method of claim 1, further comprising sendingadditional alerts using one or more of a plurality of communicationsroutes based on a severity of the alert situation in accordance withescalation rules indicating a changed patient condition.
 11. The methodof claim 1, wherein the alert situation is based on a current regulatoryrequirement.
 12. The method of claim 1, wherein the alert situation isbased on a current individual hospital initiative.
 13. The method ofclaim 1, wherein at least one of the care provider tasks is organized inthe patient screen as due within a predetermined time period andincludes a time stamp for due time.
 14. The method of claim 1, whereinthe patient specific data further comprises at least one care providerhaving contact with the patient in the room location.
 15. The method ofclaim 1, further comprising sending, using the alerting agent, the oneor more alerts to an alert repository of the clinical intelligent agent.16. The method of claim 1, further comprising storing, at an intelligentdata repository of the clinical intelligent agent, the patient specificdata in a repository, the repository storing the historical referencedata.
 17. The method of claim 1, wherein the historical reference datacomprises historical patient information derived from an electronicmedical record.
 18. The method of claim 1, further comprising storingthe one or more alerts in the alert repository as one or more historicalalerts for inclusion with the historical reference data.
 19. The methodof claim 1, wherein the displaying comprises displaying a course ofaction identified from the historical reference data.
 20. The method ofclaim 1, wherein the escalating is based upon a predetermined timeelapsing.